You may be thinking you should avoid carbohydrates at all cost since they can so easily increase insulin secretion, which packs on additional pounds of fat weight. Carbohydrates, however, are an essential part of the diet. As long as you enjoy them in balance with protein and fats, they will do just the job they were originally intended to do—provide energy to the body.
Carbohydrates, or sugars, are the fuels your body burns in each of its three trillion-plus cells to provide energy. The brain “runs” on carbohydrates (or sugars). Carbohydrates are the quickest, most readily available source of energy, and when carbohydrates are no longer available, the body burns fat, then protein. If carbohydrates are underprovided, the body is often forced to cannibalize lean body tissue to provide fuel. So it’s important to eat enough carbohydrates to satisfy the body’s energy requirement each day.
Select carbohydrates that are low on the glycemic index (see chapter 6 for this information) and avoid foods that precipitously increase blood sugar. You would do well to virtually eliminate all starchy foods, such as potatoes, yams, carrots, corn, grain products, and rice that so easily increase blood sugar. Feel free to indulge in as many “greens” as you wish. Green foods are free foods!
The problem most people have with this chart is learning what constitutes 71.5 grams of carbohydrates, or 65 grams of protein. Here are a couple of tools to put this information in a format you can use to prepare your meals.
Most animal-based proteins (seafood, poultry, veal, lamb, beef) contain about 9 grams of protein per ounce. If you require 65 grams of protein per day, plan to use about 7 1/2 ounces of seafood, poultry, or other protein per day, divided between breakfast, lunch, and dinner.
By the way, the premise of this book does not allow for a totally vegetarian lifestyle. Those who eat eggs and dairy products as part of the protein source can easily become allergic to these foods through overconsumption, and soy products will put weight on a person who is either estrogen sensitive or for whom soy pulls down the activity of the thyroid gland.
Another way to measure the amount of protein you will need at each meal is to use the palm of your hand. Plan to eat a protein portion about the size of the palm of your hand. Carbohydrates can fill up the rest of the plate, as long as you are not using any starchy vegetables, sweetened beverages, or fruit.
Remember this simple rule: You must include a protein portion with each meal if you wish to slow down the entry of sugars into your bloodstream and encourage your pancreas to secrete glucagon instead of insulin. Insulin = Fat! No more high-carb meals or snacks!
If you have indulged freely in carbohydrates (either the “good carbs” or the “bad” carbs), you are going to find this approach a little difficult to swallow, especially if you’ve been working with the vegetable/grain base type of diet. I’m going to offer you a little grace, a little leeway in starting your program, because for you this may be an enormous change in lifestyle.
When I counsel clients using this prototype, I watch their faces while I’m unrolling the plan. If they pale, if their expression goes blank, or they stand up and say, “I can’t do this! I’m outta here!” I change my approach! After all, I want them to succeed, not secede!
I encourage you to take one meal at a time (dinner, for example) and work on balancing that one meal until you are totally comfortable with the plan. This may take just a few days; it may take a few weeks. But in that one meal, make sure the proteins and carbohydrates are balanced so carefully that you begin to feel a difference. You may even start to lose a little weight!
The host of the party was serving fresh-sliced watermelon. “That’s okay. That’s okay,” I said. But after a while it just hit me. I saw those slices cut into fourths, and I said, “Just the heart.” I tried to find the biggest piece, took it, and stood there and ate the heart. I just let the juice run down my chin and over my hand, and I said, “I’m going to cherish this moment.”
J.H.
When you are totally comfortable with dinner, do lunch. Either enjoy leftovers from the evening meal or use some of the lunch suggestions in the recipe section of this book. Work with both lunch and dinner for a few weeks until this new way of eating is ingrained into your psyche. Before you know it, eating a balanced meal will seem like second nature to you.
And by the way, don’t worry if you “blow it” occasionally. We all do. Just start over again at the next meal and carry on. Your body is a wonderful organism; it has grace built into it. It can handle the occasional nutritional disaster. Just make sure you get back on track as soon as possible and make those occasional “slips” as infrequently as possible.
*56\319\2*
The ‘Europe against Cancer’ programme was launched in 1987 as a major effort to control cancer in the EC Prevention was the target, and tobacco, alcohol, diet, occupation and screening were the factors of greatest interest. As a baseline for this effort workers from the Danish Institute of Cancer Epidemiology and the International Agency for Research on Cancer in Lyon prepared a report, ‘Cancer in the European Community and its Member States’. With the permission of these authors we will quote here extensively from their report. Many of their conclusions were based on estimates, because not all EC countries collect precise information on cancer incidence. Hone the less, they concluded that the study ‘leaves little doubt that cancer represents a major health problem in the EC and its member states. The burden of cancer on society, measured by the number of new cases arising every year may be some 20 per cent higher than hitherto assumed.’
In the current twelve-member European Community, there were 750.000 deaths from cancer in 1980 and an estimated 1,200,000 new cases of cancer. Statistical methods can be employed to make allowance for the differing ages of the populations in the different countries and, when this is done, a rank order of cancer incidence and cancer deaths in men and women can be prepared;
It emerges that the risk of dying from cancer in the European Community among men it highest in Luxembourg, Belgium, France and the Netherlands and lowest in Portugal, Greece, Spain and Ireland. The difference is quite large and the incidence of cancer is 55 per cent higher among the French than among the Portuguese. The risk of dying from cancer is 40 per cent lower hi women than in men in the European Community and the highest incidence rates in women are seen in Luxembourg, the UK, Denmark and Ireland, while the lowest are seen in Spain, Greece and Portugal. There are striking disparities between countries in the differences in cancer incidence between sexes. French men are twice as likely to get cancer as French women while in Denmark men and women have a very similar incidence.
Comparing different cancers between European countries can be linked to probable causes. Liver cancer is a good example it is common in Greece, France, Italy and Spain, possibly because of a high intake of wine in these countries. This link is probably a real and causal one, and we shall be discussing it later. Nevertheless, this link probably doesn’t explain all the differences. There are other cancers associated with alcohol, including mouth cancers, and these are not particularly common in Greece. It may be that chronic liver infection with hepatitis viruses is a factor in some countries. Looking at cancer of the larynx a similar message emerges, with the French, Spanish, Italian and now Portuguese men having an alarmingly high incidence of this cancer, which is otherwise not one of the most frequent in other countries. The risk factors here are probably both tobacco and alcohol, which seem to interact to make the risk of cancer of the larynx especially high for the French.
Melanoma of the skin in Europe presents us with in interesting paradox. The high-risk countries are in northern Europe, particularly Scandinavia, the Netherlands, Germany and the UK. We shall see later that melanoma of the skin develops as a result of excessive exposure to sunlight; yet people Irving in the sunny climates in southern Europe appear to have a low incidence. The explanation lies in differences between the type of complexion found in the north and the south. The people who get melanoma appear to be those with light complexions who have intermittent exposures, leading to sunburn in young individuals and a tendency to freckle and to burn rather than tan. In North America and Australia, where the racial mix is more evenly spread through the country, the incidence of melanoma gets higher as the equator is approached and the sun gets stronger. The opposite is seen in Europe because the northern Europeans have light complexions and for them occasional exposure, perhaps on holiday in southern Europe, appears to be most harmful.
*22\194\4*
THE GEOGRAPHY OF CANCER: THE EUROPEAN COMMUNITYThe ‘Europe against Cancer’ programme was launched in 1987 as a major effort to control cancer in the EC Prevention was the target, and tobacco, alcohol, diet, occupation and screening were the factors of greatest interest. As a baseline for this effort workers from the Danish Institute of Cancer Epidemiology and the International Agency for Research on Cancer in Lyon prepared a report, ‘Cancer in the European Community and its Member States’. With the permission of these authors we will quote here extensively from their report. Many of their conclusions were based on estimates, because not all EC countries collect precise information on cancer incidence. Hone the less, they concluded that the study ‘leaves little doubt that cancer represents a major health problem in the EC and its member states. The burden of cancer on society, measured by the number of new cases arising every year may be some 20 per cent higher than hitherto assumed.’In the current twelve-member European Community, there were 750.000 deaths from cancer in 1980 and an estimated 1,200,000 new cases of cancer. Statistical methods can be employed to make allowance for the differing ages of the populations in the different countries and, when this is done, a rank order of cancer incidence and cancer deaths in men and women can be prepared; It emerges that the risk of dying from cancer in the European Community among men it highest in Luxembourg, Belgium, France and the Netherlands and lowest in Portugal, Greece, Spain and Ireland. The difference is quite large and the incidence of cancer is 55 per cent higher among the French than among the Portuguese. The risk of dying from cancer is 40 per cent lower hi women than in men in the European Community and the highest incidence rates in women are seen in Luxembourg, the UK, Denmark and Ireland, while the lowest are seen in Spain, Greece and Portugal. There are striking disparities between countries in the differences in cancer incidence between sexes. French men are twice as likely to get cancer as French women while in Denmark men and women have a very similar incidence.Comparing different cancers between European countries can be linked to probable causes. Liver cancer is a good example it is common in Greece, France, Italy and Spain, possibly because of a high intake of wine in these countries. This link is probably a real and causal one, and we shall be discussing it later. Nevertheless, this link probably doesn’t explain all the differences. There are other cancers associated with alcohol, including mouth cancers, and these are not particularly common in Greece. It may be that chronic liver infection with hepatitis viruses is a factor in some countries. Looking at cancer of the larynx a similar message emerges, with the French, Spanish, Italian and now Portuguese men having an alarmingly high incidence of this cancer, which is otherwise not one of the most frequent in other countries. The risk factors here are probably both tobacco and alcohol, which seem to interact to make the risk of cancer of the larynx especially high for the French.Melanoma of the skin in Europe presents us with in interesting paradox. The high-risk countries are in northern Europe, particularly Scandinavia, the Netherlands, Germany and the UK. We shall see later that melanoma of the skin develops as a result of excessive exposure to sunlight; yet people Irving in the sunny climates in southern Europe appear to have a low incidence. The explanation lies in differences between the type of complexion found in the north and the south. The people who get melanoma appear to be those with light complexions who have intermittent exposures, leading to sunburn in young individuals and a tendency to freckle and to burn rather than tan. In North America and Australia, where the racial mix is more evenly spread through the country, the incidence of melanoma gets higher as the equator is approached and the sun gets stronger. The opposite is seen in Europe because the northern Europeans have light complexions and for them occasional exposure, perhaps on holiday in southern Europe, appears to be most harmful.*22\194\4*
More than one taboo in brain research has been broken during the last few decades, and as with the frontal lobes, the brain mechanisms of emotions are among the previously forbidden territories that only recently opened up to rigorous scientific inquiry. Emotions had been traditionally regarded as the “soft underbelly” of psychology, the touchy-feely territory beneath the dignity of serious neuroscientists. The whole attitude had a bit of a sour grapes quality to it; until a few decades ago it was not even clear to neuroscientists where to begin their inquiry into the neurobiology of emotions.
This changed with the work by Joseph LeDoux, Richard Davidson, Antonio Damasio, and others who finally infused the subject with rigorous scientific methods. LeDoux mapped out the role of the amygdala in emotions. The amygdala is a phylogenetically old subcortical structure, part of the “limbic brain.” which suggests that the mechanisms of emotions began to emerge at relatively early stages of evolution. By contrast, for years the tacit assumption ruled that the youngest part of the brain, the neocortex, is involved in dispassionate, rational, emotionally barren deliberation. This implied a neat dichotomy of our inner world: the inner world of emotion governed by the “hot” subcortical limbic structures, and the inner world of rational thought governed by the “cool” neocortex.
The dichotomy was too neat to be true and it wasn’t. Emotional experience and emotional expression clearly involve the neocortex as well. What’s more, the cortical representation of emotions is split. The left hemisphere is involved in positive emotions, and the right hemisphere is involved in negative emotions.
The first inkling about the hemispheric division of labor in emotions came from the observations of patients with brain damage. Clinicians have known for years that damage to the left hemisphere frequently produces depression. By contrast, damage to the right hemisphere frequently produces mania, or what could pass for shallow euphoria (or at least a state of nonchalance known by the clinical term belle indifference). Both effects, those of left-sided lesions and those of right-sided lesions, were particularly striking when patients’ reactions to various emotional stimuli were compared to those of normal people.
It was common in the past to regard these lateralized effects of brain damage on emotions as the remote consequences of an uneven degree of patients’ awareness of their deficit. As we already know, in adults damage to the left hemisphere interferes with language. Since language is such an important and all-embracing skill, its loss cannot remain unnoticed by the patient and it becomes the source of intense distress. By contrast, the functions of the right hemisphere are more elusive, less available to introspection. Patients are usually less aware of the loss of these functions and are therefore less perturbed by their loss. The impression of nonchalance when there is every reason to be depressed could be misinterpreted as euphoria, as the reasoning went.
Indeed, a patient with right-hemispheric damage often displays astounding unawareness of the deficit, a phenomenon known as anosognosia. The blissful aura of equanimity projected by these patients stands in stark contradiction with the sad reality of the catastrophic brain damage many of them suffered.
Anosognosia often takes the form of “left hemineglect,” a condition that occurs when the brain fails to properly register and process information coming from the left half of the outside world. The condition is possible because the sensory pathways carrying information about the outside world to the brain are mostly crossed: Information about the left-hand half of the world is sent to the right hemisphere and information about the right-hand half of the world is sent to the left hemisphere. When a lesion affects the left side of the brain, the patient usually discovers the consequent handicap quite easily and learns how to compensate for it. But when a lesion affects the right side of the brain, the patient often remains unaware of the consequences and fails to compensate, and the left hemineglect becomes severe and intractable.
Anosognosia sometimes takes rather surreal forms, when the failure to recognize a problem within results in fantastic accounts about the world outside, such as the nursing home patient discussed earlier who was unable to find his steak on the cafeteria tray and blamed this on a conspiracy of nurses. But left hemineglect and hemiinattention are not limited to the visual sensations. The tactile sensations may also be affected, producing the so-called “alien hand” phenomenon. A stroke patient afflicted with this condition will disown the left side of his own body as belonging to another person, will ad lib a bizarre story explaining what the “alien” hand is doing next to him, and will not be in the least concerned about his own neurological condition.
By contrast, a patient with aphasia (language impairment) caused by a left-hemispheric stroke is often acutely aware of his handicap and is tormented by it, frightened and tearful. This has frequently led to the conjecture that depression in such patients is a reaction to their cognitive loss.
But further research has shown that there is more to the connection between hemispheres and affect than the differences in the degree of awareness of deficit. A hemisphere is a big place, and linking certain symptoms to damage somewhere within a hemisphere is not enough. It is important to know where exactly within the hemisphere the offending damage is found. When this question was asked, it turned out that damage to the left frontal lobe is particularly likely to produce depression, more so than damage to any other part of the left hemisphere.
But therein lies a riddle. As we already know, frontal-lobe injury also causes anosognosia. A patient with significant damage to the left frontal regions is just not sufficiently aware of his or her deficit to be bothered by it. Therefore, linking depression to the awareness of deficit caused by a left frontal lesion amounts to a highly implausible proposition. On the other hand, damage to the right frontal regions often produces a much-more-than-blas? nonchalance, which could not be explained away simply by unawareness of deficit. Such lesions often produce mania or outright euphoria.
It has also been noted that at times damage to one or the other hemisphere produces emotionally charged behaviors so extreme that they cannot be explained by the degrees of awareness of deficit. Patients with left-hemispheric lesions sometimes engage in pathological crying and patients with right-hemispheric lesions occasionally engage in pathological laughter. So the side of hemispheric damage had to be linked to these changes of affect.
The next step was to study the relationship between emotional states and the two sides of the brain in normal people. This was first accomplished using EEG, which remained the mainstay of such research in the 1970s and 1980s. The advent of functional neuroimaging (PET, and fMRI) in the years that followed made possible an even more direct glimpse into the relationship between affect and the two sides of the brain. Much of this work has been pioneered by Richard Davidson and his colleagues.
The findings were quite intriguing. When normal subjects were shown film clips or other images containing pleasant information, the activation increased in the left hemisphere, particularly in the left prefrontal cortex. By contrast, when subjects were shown unpleasant or sad images, activation increased in the right hemisphere, again mostly in the right prefrontal cortex. A similar contrast was evident in a video game with financial implications. When the subjects stood to make money, a relatively greater activation of the left frontal lobe was recorded. But when the subjects stood to lose money, there was a relatively greater activation of the right frontal lobe. When the brain mechanisms of various spiritual experiences were studied, similar effects were found. Meditation leading to the immersion into a soothing, introspective frame of mind activated the left prefrontal cortex and decreased the right prefrontal activation. An increase of activation was found in the left frontal regions in meditating nuns, as well as a decrease in various regions of the right hemisphere.
Taken together, the studies of brain damage and the neuroimaging studies in normal people clearly indicated that the two hemispheres play rather direct, opposite roles in the experience and expression of emotions. The left hemisphere mediates positive emotions and the right hemisphere mediates negative emotions: truly the Yin and Yang in the brain.
41\302\2*
MAGELLAN ON PROZAC: THE YIN AND YANG IN THE BRAINMore than one taboo in brain research has been broken during the last few decades, and as with the frontal lobes, the brain mechanisms of emotions are among the previously forbidden territories that only recently opened up to rigorous scientific inquiry. Emotions had been traditionally regarded as the “soft underbelly” of psychology, the touchy-feely territory beneath the dignity of serious neuroscientists. The whole attitude had a bit of a sour grapes quality to it; until a few decades ago it was not even clear to neuroscientists where to begin their inquiry into the neurobiology of emotions.This changed with the work by Joseph LeDoux, Richard Davidson, Antonio Damasio, and others who finally infused the subject with rigorous scientific methods. LeDoux mapped out the role of the amygdala in emotions. The amygdala is a phylogenetically old subcortical structure, part of the “limbic brain.” which suggests that the mechanisms of emotions began to emerge at relatively early stages of evolution. By contrast, for years the tacit assumption ruled that the youngest part of the brain, the neocortex, is involved in dispassionate, rational, emotionally barren deliberation. This implied a neat dichotomy of our inner world: the inner world of emotion governed by the “hot” subcortical limbic structures, and the inner world of rational thought governed by the “cool” neocortex.The dichotomy was too neat to be true and it wasn’t. Emotional experience and emotional expression clearly involve the neocortex as well. What’s more, the cortical representation of emotions is split. The left hemisphere is involved in positive emotions, and the right hemisphere is involved in negative emotions. The first inkling about the hemispheric division of labor in emotions came from the observations of patients with brain damage. Clinicians have known for years that damage to the left hemisphere frequently produces depression. By contrast, damage to the right hemisphere frequently produces mania, or what could pass for shallow euphoria (or at least a state of nonchalance known by the clinical term belle indifference). Both effects, those of left-sided lesions and those of right-sided lesions, were particularly striking when patients’ reactions to various emotional stimuli were compared to those of normal people.It was common in the past to regard these lateralized effects of brain damage on emotions as the remote consequences of an uneven degree of patients’ awareness of their deficit. As we already know, in adults damage to the left hemisphere interferes with language. Since language is such an important and all-embracing skill, its loss cannot remain unnoticed by the patient and it becomes the source of intense distress. By contrast, the functions of the right hemisphere are more elusive, less available to introspection. Patients are usually less aware of the loss of these functions and are therefore less perturbed by their loss. The impression of nonchalance when there is every reason to be depressed could be misinterpreted as euphoria, as the reasoning went.Indeed, a patient with right-hemispheric damage often displays astounding unawareness of the deficit, a phenomenon known as anosognosia. The blissful aura of equanimity projected by these patients stands in stark contradiction with the sad reality of the catastrophic brain damage many of them suffered.Anosognosia often takes the form of “left hemineglect,” a condition that occurs when the brain fails to properly register and process information coming from the left half of the outside world. The condition is possible because the sensory pathways carrying information about the outside world to the brain are mostly crossed: Information about the left-hand half of the world is sent to the right hemisphere and information about the right-hand half of the world is sent to the left hemisphere. When a lesion affects the left side of the brain, the patient usually discovers the consequent handicap quite easily and learns how to compensate for it. But when a lesion affects the right side of the brain, the patient often remains unaware of the consequences and fails to compensate, and the left hemineglect becomes severe and intractable.Anosognosia sometimes takes rather surreal forms, when the failure to recognize a problem within results in fantastic accounts about the world outside, such as the nursing home patient discussed earlier who was unable to find his steak on the cafeteria tray and blamed this on a conspiracy of nurses. But left hemineglect and hemiinattention are not limited to the visual sensations. The tactile sensations may also be affected, producing the so-called “alien hand” phenomenon. A stroke patient afflicted with this condition will disown the left side of his own body as belonging to another person, will ad lib a bizarre story explaining what the “alien” hand is doing next to him, and will not be in the least concerned about his own neurological condition.By contrast, a patient with aphasia (language impairment) caused by a left-hemispheric stroke is often acutely aware of his handicap and is tormented by it, frightened and tearful. This has frequently led to the conjecture that depression in such patients is a reaction to their cognitive loss.But further research has shown that there is more to the connection between hemispheres and affect than the differences in the degree of awareness of deficit. A hemisphere is a big place, and linking certain symptoms to damage somewhere within a hemisphere is not enough. It is important to know where exactly within the hemisphere the offending damage is found. When this question was asked, it turned out that damage to the left frontal lobe is particularly likely to produce depression, more so than damage to any other part of the left hemisphere.But therein lies a riddle. As we already know, frontal-lobe injury also causes anosognosia. A patient with significant damage to the left frontal regions is just not sufficiently aware of his or her deficit to be bothered by it. Therefore, linking depression to the awareness of deficit caused by a left frontal lesion amounts to a highly implausible proposition. On the other hand, damage to the right frontal regions often produces a much-more-than-blas? nonchalance, which could not be explained away simply by unawareness of deficit. Such lesions often produce mania or outright euphoria.It has also been noted that at times damage to one or the other hemisphere produces emotionally charged behaviors so extreme that they cannot be explained by the degrees of awareness of deficit. Patients with left-hemispheric lesions sometimes engage in pathological crying and patients with right-hemispheric lesions occasionally engage in pathological laughter. So the side of hemispheric damage had to be linked to these changes of affect.The next step was to study the relationship between emotional states and the two sides of the brain in normal people. This was first accomplished using EEG, which remained the mainstay of such research in the 1970s and 1980s. The advent of functional neuroimaging (PET, and fMRI) in the years that followed made possible an even more direct glimpse into the relationship between affect and the two sides of the brain. Much of this work has been pioneered by Richard Davidson and his colleagues.The findings were quite intriguing. When normal subjects were shown film clips or other images containing pleasant information, the activation increased in the left hemisphere, particularly in the left prefrontal cortex. By contrast, when subjects were shown unpleasant or sad images, activation increased in the right hemisphere, again mostly in the right prefrontal cortex. A similar contrast was evident in a video game with financial implications. When the subjects stood to make money, a relatively greater activation of the left frontal lobe was recorded. But when the subjects stood to lose money, there was a relatively greater activation of the right frontal lobe. When the brain mechanisms of various spiritual experiences were studied, similar effects were found. Meditation leading to the immersion into a soothing, introspective frame of mind activated the left prefrontal cortex and decreased the right prefrontal activation. An increase of activation was found in the left frontal regions in meditating nuns, as well as a decrease in various regions of the right hemisphere.Taken together, the studies of brain damage and the neuroimaging studies in normal people clearly indicated that the two hemispheres play rather direct, opposite roles in the experience and expression of emotions. The left hemisphere mediates positive emotions and the right hemisphere mediates negative emotions: truly the Yin and Yang in the brain.41\302\2*
Intraperitoneal abscesses may develop as a consequence of diffuse peritonitis with localization of pus in dependent regions such as the pelvis, paracolic gutters, and subphrenic areas, or by direct extension of infection from a diseased organ (especially periappendiceal or diverticular abscesses). Almost half of all intraperitoneal abscesses occur in the right lower quadrant due to rupture of the appendix. Postoperative anastomotic leaks also account for a large percentage of intra-abdominal abscesses. The microbiology is generally the same as that involved in secondary and tertiary peritonitis, and the antibiotics used in management are similar. Both aerobic and anaerobic organisms are required for abscess formation.
Computed tomography and ultrasonography have simplified the diagnosis of intra-abdominal abscess. CT is generally superior to ultrasonography, with an overall sensitivity for detecting abscesses of 78% to 100%, compared with 75% to 82% for ultrasonography. CT is more accurate and sensitive than ultrasonography; with the exception of detecting lesions in the pelvis and right upper quadrant.
The main therapy for any intraperitoneal abscess is drainage. Although conventional therapy has involved surgical drainage, recent /ears have seen the successful use of percutaneous drainage as an alternative to surgery, made possible by refined imaging techniques.
*95/348/5*
INTRAPERITONEAL ABSCESSIntraperitoneal abscesses may develop as a consequence of diffuse peritonitis with localization of pus in dependent regions such as the pelvis, paracolic gutters, and subphrenic areas, or by direct extension of infection from a diseased organ (especially periappendiceal or diverticular abscesses). Almost half of all intraperitoneal abscesses occur in the right lower quadrant due to rupture of the appendix. Postoperative anastomotic leaks also account for a large percentage of intra-abdominal abscesses. The microbiology is generally the same as that involved in secondary and tertiary peritonitis, and the antibiotics used in management are similar. Both aerobic and anaerobic organisms are required for abscess formation.Computed tomography and ultrasonography have simplified the diagnosis of intra-abdominal abscess. CT is generally superior to ultrasonography, with an overall sensitivity for detecting abscesses of 78% to 100%, compared with 75% to 82% for ultrasonography. CT is more accurate and sensitive than ultrasonography; with the exception of detecting lesions in the pelvis and right upper quadrant.The main therapy for any intraperitoneal abscess is drainage. Although conventional therapy has involved surgical drainage, recent /ears have seen the successful use of percutaneous drainage as an alternative to surgery, made possible by refined imaging techniques.*95/348/5*
Another way your sleep can be disturbed is through pain, discomfort, or twitching in the legs. One form of this condition bears the nontechnical name “restless legs syndrome.” If you are a victim of the syndrome, you experience a disagreeable sensation in the calves and feet. Some patients describe twitching or a feeling of “creepy crawling” in the skin, which causes an almost uncontrollable urge to move the legs by walking or shaking or massaging them. This feeling tends to occur during the process of falling asleep, and thus delaying sleep onset; in some cases, however, it can start later and awaken you, forcing you to leave your bed and walk around. Restless legs can be an inherited condition; it may also arise as a complication of pregnancy.
There are drugs that may help the problem: for years doctors in England have treated leg cramps (which they aptly call “the fidgets”) with quinine sulfate. Some physicians detect improvement after administering preparations containing all of the B vitamins. Others report success using temazepam (Restoril) or a drug called carbamazepine (sold as Tegretol).
timated one out of three people over the age of sixty-five are thought to suffer from the problem. The drug temazepam may provide relief; if after a few weeks the problem persists, some physicians may decide to prescribe a drug called clonazepam (marketed as Klonopin). No one is certain if clonazepam works because it relaxes leg muscles or because it possesses anticonvulsive properties.
*123\226\8*
DIFFICULTY FALLING OR STAYING ASLEEP: RESTLESS LEGSAnother way your sleep can be disturbed is through pain, discomfort, or twitching in the legs. One form of this condition bears the nontechnical name “restless legs syndrome.” If you are a victim of the syndrome, you experience a disagreeable sensation in the calves and feet. Some patients describe twitching or a feeling of “creepy crawling” in the skin, which causes an almost uncontrollable urge to move the legs by walking or shaking or massaging them. This feeling tends to occur during the process of falling asleep, and thus delaying sleep onset; in some cases, however, it can start later and awaken you, forcing you to leave your bed and walk around. Restless legs can be an inherited condition; it may also arise as a complication of pregnancy.There are drugs that may help the problem: for years doctors in England have treated leg cramps (which they aptly call “the fidgets”) with quinine sulfate. Some physicians detect improvement after administering preparations containing all of the B vitamins. Others report success using temazepam (Restoril) or a drug called carbamazepine (sold as Tegretol).timated one out of three people over the age of sixty-five are thought to suffer from the problem. The drug temazepam may provide relief; if after a few weeks the problem persists, some physicians may decide to prescribe a drug called clonazepam (marketed as Klonopin). No one is certain if clonazepam works because it relaxes leg muscles or because it possesses anticonvulsive properties.*123\226\8*
A water-soluble vitamin, B1 is one of the safest supplements. It has been said that just adding a little B1 to everyone’s diet would prevent thousands of cases of alcohol-induced brain damage and the even more devastating ‘foetal alcohol syndrome’ which can affect babies born of alcohol abusers.
You should choose a high B1 formula if you drink alcohol, consume lots of sugars, refined carbohydrates or tea, or if you suffer with respiratory allergies, especially asthma, or neurological problems such as MS or peripheral neuropathy. B1, combined with calcium and sometimes with B12, is also very helpful in cases of anxiety and hyperactivity.
While this nutrient is effective in calming down the nervous system of anxiety and asthma sufferers, however, at doses exceeding 2000 mg daily for long periods it can cause symptoms similar to those caused by an overdose of thyroid hormone: headaches, insomnia, irritability, rapid pulse, weakness and trembling. The symptoms stop on ceasing the supplements and they do not cause any permanent damage.
Injectable vitamin B1 has been reported to cause allergic reactions in a few sensitive individuals when administered intramuscularly. Intravenously, vitamin B1 should be given very slowly, because if the injection is too rapid it can cause serious side effects, even death. There seem to be no side-effect problems with oral B1. Vitamin B1 is easily destroyed by alkalinity, so prolonged use of antacids may cause a deficiency.
*45\145\2*
DIETS AND ASTHMA: VITAMIN B1 (THIAMINE)A water-soluble vitamin, B1 is one of the safest supplements. It has been said that just adding a little B1 to everyone’s diet would prevent thousands of cases of alcohol-induced brain damage and the even more devastating ‘foetal alcohol syndrome’ which can affect babies born of alcohol abusers.You should choose a high B1 formula if you drink alcohol, consume lots of sugars, refined carbohydrates or tea, or if you suffer with respiratory allergies, especially asthma, or neurological problems such as MS or peripheral neuropathy. B1, combined with calcium and sometimes with B12, is also very helpful in cases of anxiety and hyperactivity.While this nutrient is effective in calming down the nervous system of anxiety and asthma sufferers, however, at doses exceeding 2000 mg daily for long periods it can cause symptoms similar to those caused by an overdose of thyroid hormone: headaches, insomnia, irritability, rapid pulse, weakness and trembling. The symptoms stop on ceasing the supplements and they do not cause any permanent damage.Injectable vitamin B1 has been reported to cause allergic reactions in a few sensitive individuals when administered intramuscularly. Intravenously, vitamin B1 should be given very slowly, because if the injection is too rapid it can cause serious side effects, even death. There seem to be no side-effect problems with oral B1. Vitamin B1 is easily destroyed by alkalinity, so prolonged use of antacids may cause a deficiency.*45\145\2*
Protect your inflamed joints
Protecting inflamed joints from excessive stress will decrease pain. Your occupational therapist, an expert in this area, will be an invaluable source of information to you. Skills for protecting your joints only require a little extra time and once you see how effective they are, you undoubtedly will make them an automatic part of your daily life.
Improve your muscle health
The two methods of improving your muscle health are to (1) reduce muscle tension and (2) increase muscle strength. We have described how muscle tension contributes to joint pain. Certainly, warm baths or showers, warm compresses, relaxation techniques, gentle message, imagery techniques, adequate rest and sleep, and tailored exercises will be of great value in reducing muscle tension. You can learn to do many of these treatments for yourself.
Increasing muscle strength is an excellent way to take stress (and thus pain) away from joints by providing increased structural support. A physical therapist trained in arthritis treatment can instruct you in exercise programs designed to increase muscle strength. (Physical therapists can assist you with other techniques for effectively reducing pain; electrical stimulation, ultrasound, and hydrotherapy are examples.)
*43/209/5*
DECREASING PAIN DURING RHEUMATOID ARTHRITIS (RA): OPTIONS TO FOLLOWProtect your inflamed joints Protecting inflamed joints from excessive stress will decrease pain. Your occupational therapist, an expert in this area, will be an invaluable source of information to you. Skills for protecting your joints only require a little extra time and once you see how effective they are, you undoubtedly will make them an automatic part of your daily life.
Improve your muscle healthThe two methods of improving your muscle health are to (1) reduce muscle tension and (2) increase muscle strength. We have described how muscle tension contributes to joint pain. Certainly, warm baths or showers, warm compresses, relaxation techniques, gentle message, imagery techniques, adequate rest and sleep, and tailored exercises will be of great value in reducing muscle tension. You can learn to do many of these treatments for yourself.Increasing muscle strength is an excellent way to take stress (and thus pain) away from joints by providing increased structural support. A physical therapist trained in arthritis treatment can instruct you in exercise programs designed to increase muscle strength. (Physical therapists can assist you with other techniques for effectively reducing pain; electrical stimulation, ultrasound, and hydrotherapy are examples.)*43/209/5*
When it comes to curbing cholesterol, choosing to limit or avoid certain foods is not the whole story: Adding certain beneficial items to your eating plan can actively keep blood levels under control. Recent studies have found that beans, peas, lentils, oats, yams, barley, and most vegetables and fruits contain soluble fibers that have been shown to actively lower serum cholesterol. The gums and pectins found in these foods may increase the excretion of cholesterol-derived bile acids, and thereby promote the net excretion of cholesterol from the body. Just like certain cholesterol-lowering drugs (but without the danger of harmful side effects!), the fibers found in these foods allow more cholesterol to be converted to bile acids, which can then be excreted from the body. Here’s how: Soluble fiber binds with bile acids, depleting the liver’s supply of them and causing it to produce more, using its own cholesterol. When the liver’s supply of cholesterol is depleted, it extracts LDL cholesterol from the bloodstream to build up its store of cholesterol again. And soluble fibers also delay the absorption of carbohydrates and thereby lower serum insulin levels, which research suggests may help reduce cholesterol synthesis by the liver.
*8/345/5*
HOW FOODS DECREASE CHOLESTEROLWhen it comes to curbing cholesterol, choosing to limit or avoid certain foods is not the whole story: Adding certain beneficial items to your eating plan can actively keep blood levels under control. Recent studies have found that beans, peas, lentils, oats, yams, barley, and most vegetables and fruits contain soluble fibers that have been shown to actively lower serum cholesterol. The gums and pectins found in these foods may increase the excretion of cholesterol-derived bile acids, and thereby promote the net excretion of cholesterol from the body. Just like certain cholesterol-lowering drugs (but without the danger of harmful side effects!), the fibers found in these foods allow more cholesterol to be converted to bile acids, which can then be excreted from the body. Here’s how: Soluble fiber binds with bile acids, depleting the liver’s supply of them and causing it to produce more, using its own cholesterol. When the liver’s supply of cholesterol is depleted, it extracts LDL cholesterol from the bloodstream to build up its store of cholesterol again. And soluble fibers also delay the absorption of carbohydrates and thereby lower serum insulin levels, which research suggests may help reduce cholesterol synthesis by the liver.*8/345/5*
The many purported benefits of HRT range from relief of transitory menopausal symptoms such as hot flashes to lowering the long-term risk of developing osteoporosis and possibly heart disease. Preliminary studies also suggest that HRT may reduce risk for Alzheimer’s disease, colon cancer, and strokes. But the decision to use HRT is still clouded in controversy, particularly since two principal components of HRT – estrogen and progestin – appear to affect breast tissue. When taken alone, estrogen significantly increases the risk of uterine cancer also, so probably the only women who should be taking estrogen alone are those who’ve had complete hysterectomies. Additionally, some studies have found that estrogen may cause a small increase in breast cancer, particularly in those who already are predisposed to breast cancer through family and genetic or environmental risks. Unfortunately, although it is commonly assumed by many that HRT and increased breast cancer risk are synonymous, such is not the case. Research to date has been limited and does not provide clear associations between the two. Several long-term studies are under way through the Women’s Health Initiative and other projects, but results are still at least 5 years away. Other researchers are concerned that progestins may also increase risk for breast cancer, a possibility even more inconclusive than questions about estrogen. A recent study published in the April 2000 issue of Obstetrics and Gynecology suggests that women who get breast cancer while taking HRT tend to have smaller tumors and better survival rates than women with breast cancer who’ve never taken HRT.
What does all of this mean to you? Because there is so much uncertainty about risks and benefits of HRT, women should thoroughly check out information about dose, formulations, and length of treatment when considering HRT. Most experts suggest that benefits of HRT (protection from CVD and osteoporosis in particular) outweigh the small risk of breast cancer. Also, it is important to note that in studies where estrogen has appeared to slightly increase risk, women had been taking it for more than 5 years at relatively high doses. Today’s formulations, offered under the guidance of an informed women’s health physician and combined with regular mammograms and other screenings, appear to be important elements of overall risk reduction.
*17/277/5*
HRT AND BREAST CANCERThe many purported benefits of HRT range from relief of transitory menopausal symptoms such as hot flashes to lowering the long-term risk of developing osteoporosis and possibly heart disease. Preliminary studies also suggest that HRT may reduce risk for Alzheimer’s disease, colon cancer, and strokes. But the decision to use HRT is still clouded in controversy, particularly since two principal components of HRT – estrogen and progestin – appear to affect breast tissue. When taken alone, estrogen significantly increases the risk of uterine cancer also, so probably the only women who should be taking estrogen alone are those who’ve had complete hysterectomies. Additionally, some studies have found that estrogen may cause a small increase in breast cancer, particularly in those who already are predisposed to breast cancer through family and genetic or environmental risks. Unfortunately, although it is commonly assumed by many that HRT and increased breast cancer risk are synonymous, such is not the case. Research to date has been limited and does not provide clear associations between the two. Several long-term studies are under way through the Women’s Health Initiative and other projects, but results are still at least 5 years away. Other researchers are concerned that progestins may also increase risk for breast cancer, a possibility even more inconclusive than questions about estrogen. A recent study published in the April 2000 issue of Obstetrics and Gynecology suggests that women who get breast cancer while taking HRT tend to have smaller tumors and better survival rates than women with breast cancer who’ve never taken HRT.What does all of this mean to you? Because there is so much uncertainty about risks and benefits of HRT, women should thoroughly check out information about dose, formulations, and length of treatment when considering HRT. Most experts suggest that benefits of HRT (protection from CVD and osteoporosis in particular) outweigh the small risk of breast cancer. Also, it is important to note that in studies where estrogen has appeared to slightly increase risk, women had been taking it for more than 5 years at relatively high doses. Today’s formulations, offered under the guidance of an informed women’s health physician and combined with regular mammograms and other screenings, appear to be important elements of overall risk reduction.*17/277/5*
But nothing is perfect. We have to live in a world that is not perfect with people who are full of quirks and in homes that have imperfections. I have a friend who saved and scrimped to buy some expensive wallpaper for her son’s bedroom. It finally arrived after being special-ordered, and she brought it home and put it away, planning to hang it as soon as she found the time.
Her husband discovered the wallpaper and, while she was out shopping for the day, he decided to surprise her by hanging it himself. So he worked all day, papering the entire bedroom with the lovely new paper, which was supposed to show colorful balloons with the strings hanging down. He made only one mistake: he hung all the paper UPSIDE DOWN, and the strings were all pointing up the wall like slithering snakes instead of hanging down gracefully as intended.
When my friend returned, she was shocked, but it was all done and couldn’t be changed. So, she and her husband simply learned to live with the upside down wallpaper and adjusted to seeing the strings going up. She had wanted it to be just perfect, but it had come out exactly opposite of what she had planned. Learning to live with upside down situations is not always easy, but it is part of life because we all face living with imperfect situations.
We have a clock in our car that is always one hour off from October to April when the time changes. The mechanism that changes the dial is broken, and during those months I have to keep remembering that the clock in our car is one hour ahead of life. I have to keep adjusting my time and schedule according to a clock that is one hour off, and perhaps this is teaching me something. Some things in life are NEVER what they should be and you have to adjust. Being willing to adjust to something less than perfect is a sign of acceptance.
One heart-broken parent, whose child had disappointed her terribly, finally came to terms with her trials. One of the things that helped her was this little poem:
ACCEPTANCE
Acceptance is the answer to all my problems today. When I am disturbed, it is because I find some
person, place, thing, or situation— Some fact of my life—unacceptable to me, and
I can find no serenity until I accept that
person, place, thing, or situation as being exactly
the way it is supposed to be at this moment, Nothing, absolutely nothing happens in
God’s world by mistake. Unless I accept life completely on life’s terms,
I cannot be happy. I need to concentrate not so much on what needs to
be changed in the world as on what needs to
be changed in me and in my attitudes.
—Source Unknown
I got a letter from a dear lady who admitted she had no offering to send for the SPATULA ministry, but her love and prayers are with us. She said:
My husband has not worked in four years since his legs were both amputated from an accident. My son is in contact with us now, thanks to SPATULA, and he has moved near us to help with the farming. I have recovered from my surgery for breast cancer, and thank the Lord for that. However, the eye problem I told you about has increased so much the doctors tell me that I will lose all my sight within a few months. But I am thankful my husband can read to me when I go blind, and he will interpret all the cartoons and jokes for me so we can laugh together when your newsletter comes each month. I have laughed more over your newsletter than all the smiles I could muster since these trials came to us. How I praise the Lord for SPATULA and the laughter it brings to me, along with the encouragement to hang on when everything looks so black.
In her pain, facing problems that would leave many people distraught, this lady still has reason to hope!
*20\316\2*
LIFE CAN TURN UPSIDE DOWNBut nothing is perfect. We have to live in a world that is not perfect with people who are full of quirks and in homes that have imperfections. I have a friend who saved and scrimped to buy some expensive wallpaper for her son’s bedroom. It finally arrived after being special-ordered, and she brought it home and put it away, planning to hang it as soon as she found the time.Her husband discovered the wallpaper and, while she was out shopping for the day, he decided to surprise her by hanging it himself. So he worked all day, papering the entire bedroom with the lovely new paper, which was supposed to show colorful balloons with the strings hanging down. He made only one mistake: he hung all the paper UPSIDE DOWN, and the strings were all pointing up the wall like slithering snakes instead of hanging down gracefully as intended.When my friend returned, she was shocked, but it was all done and couldn’t be changed. So, she and her husband simply learned to live with the upside down wallpaper and adjusted to seeing the strings going up. She had wanted it to be just perfect, but it had come out exactly opposite of what she had planned. Learning to live with upside down situations is not always easy, but it is part of life because we all face living with imperfect situations.We have a clock in our car that is always one hour off from October to April when the time changes. The mechanism that changes the dial is broken, and during those months I have to keep remembering that the clock in our car is one hour ahead of life. I have to keep adjusting my time and schedule according to a clock that is one hour off, and perhaps this is teaching me something. Some things in life are NEVER what they should be and you have to adjust. Being willing to adjust to something less than perfect is a sign of acceptance.One heart-broken parent, whose child had disappointed her terribly, finally came to terms with her trials. One of the things that helped her was this little poem:ACCEPTANCEAcceptance is the answer to all my problems today. When I am disturbed, it is because I find someperson, place, thing, or situation— Some fact of my life—unacceptable to me, andI can find no serenity until I accept thatperson, place, thing, or situation as being exactlythe way it is supposed to be at this moment, Nothing, absolutely nothing happens inGod’s world by mistake. Unless I accept life completely on life’s terms,I cannot be happy. I need to concentrate not so much on what needs tobe changed in the world as on what needs tobe changed in me and in my attitudes.—Source UnknownI got a letter from a dear lady who admitted she had no offering to send for the SPATULA ministry, but her love and prayers are with us. She said:My husband has not worked in four years since his legs were both amputated from an accident. My son is in contact with us now, thanks to SPATULA, and he has moved near us to help with the farming. I have recovered from my surgery for breast cancer, and thank the Lord for that. However, the eye problem I told you about has increased so much the doctors tell me that I will lose all my sight within a few months. But I am thankful my husband can read to me when I go blind, and he will interpret all the cartoons and jokes for me so we can laugh together when your newsletter comes each month. I have laughed more over your newsletter than all the smiles I could muster since these trials came to us. How I praise the Lord for SPATULA and the laughter it brings to me, along with the encouragement to hang on when everything looks so black.In her pain, facing problems that would leave many people distraught, this lady still has reason to hope!*20\316\2*
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